EP1778351B1 - Verification des caracteristiques d'une lesion au moyen de formes de faisceaux - Google Patents

Verification des caracteristiques d'une lesion au moyen de formes de faisceaux Download PDF

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Publication number
EP1778351B1
EP1778351B1 EP05763463A EP05763463A EP1778351B1 EP 1778351 B1 EP1778351 B1 EP 1778351B1 EP 05763463 A EP05763463 A EP 05763463A EP 05763463 A EP05763463 A EP 05763463A EP 1778351 B1 EP1778351 B1 EP 1778351B1
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Prior art keywords
dimensional
lesion
image
treatment
beam shape
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German (de)
English (en)
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EP1778351A1 (fr
EP1778351A4 (fr
Inventor
Tony Falco
François PERRATON
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Resonant Medical Inc
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Resonant Medical Inc
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
    • A61N5/1048—Monitoring, verifying, controlling systems and methods
    • A61N5/1049—Monitoring, verifying, controlling systems and methods for verifying the position of the patient with respect to the radiation beam
    • G—PHYSICS
    • G21—NUCLEAR PHYSICS; NUCLEAR ENGINEERING
    • G21K—TECHNIQUES FOR HANDLING PARTICLES OR IONISING RADIATION NOT OTHERWISE PROVIDED FOR; IRRADIATION DEVICES; GAMMA RAY OR X-RAY MICROSCOPES
    • G21K1/00—Arrangements for handling particles or ionising radiation, e.g. focusing or moderating
    • G21K1/02—Arrangements for handling particles or ionising radiation, e.g. focusing or moderating using diaphragms, collimators
    • G21K1/04—Arrangements for handling particles or ionising radiation, e.g. focusing or moderating using diaphragms, collimators using variable diaphragms, shutters, choppers
    • G21K1/046—Arrangements for handling particles or ionising radiation, e.g. focusing or moderating using diaphragms, collimators using variable diaphragms, shutters, choppers varying the contour of the field, e.g. multileaf collimators
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
    • A61N5/1042—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy with spatial modulation of the radiation beam within the treatment head
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
    • A61N5/1048—Monitoring, verifying, controlling systems and methods
    • A61N5/1064—Monitoring, verifying, controlling systems and methods for adjusting radiation treatment in response to monitoring
    • A61N5/1065—Beam adjustment
    • A61N5/1067—Beam adjustment in real time, i.e. during treatment
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
    • A61N5/1048—Monitoring, verifying, controlling systems and methods
    • A61N5/1064—Monitoring, verifying, controlling systems and methods for adjusting radiation treatment in response to monitoring
    • A61N5/1069—Target adjustment, e.g. moving the patient support
    • A61N5/107—Target adjustment, e.g. moving the patient support in real time, i.e. during treatment

Definitions

  • This invention relates to methods and systems for verifying anatomical features of a patient undergoing radiation therapy and, more particularly, to methods and systems for positioning patients using planned radiation beam shapes.
  • a radiation therapy device includes a gantry that can be rotated around a horizontal axis of rotation during the delivery of a therapeutic treatment.
  • a particle linear accelerator (“LINAC") is located within the gantry, and generates a high-energy radiation beam of therapy, such as an electron beam or photon (x-ray) beam.
  • LINAC particle linear accelerator
  • the patient is placed on a treatment table located at the isocenter of the gantry, and the radiation beam is directed towards the tumor or lesion to be treated.
  • Radiation therapy typically involves a planning stage and a treatment stage.
  • an X-ray computed tomography (CT) scanner (or similar device) is used to acquire images of a lesion. These images are used to accurately measure the location, size, contour, and number of lesions to be treated in order to establish an isocenter, a dose distribution, and various irradiation parameters in an attempt to irradiate the lesion while minimizing damage to surrounding healthy tissue.
  • CT computed tomography
  • 3DCRT and IMRT use multiple, intersecting, shaped radiation beams, each of which geometrically conforms to the shape of a tumor from the view point of the origin of the radiation beam (the "beam's eye view,” or "BEV").
  • BEV the view point of the origin of the radiation beam
  • Various types of devices are used to conform the shape of the radiation treatment beam to encompass the tumor along the radiation treatment BEV as it traverses the patient's body into the tumor.
  • One such beam-shielding device is the multi-leaf collimator (“MLC").
  • LINACs with MLCs facilitate delivery to a patient of radiation beams with arbitrary shapes and distributions.
  • the MLC patterns can be defined during planning, and coupled with 3D conformal treatment planning techniques, they allow treatment plans to be more flexible and complex.
  • Such MLC-based 3DCRT plans prescribe radiation field geometries tailored to fit the tumor's shape more accurately than previous, 2D block-shaped plans. As a result, higher doses can be targeted at the tumor, requiring tighter safety margins around the tumor to avoid damaging healthy tissue by exposing it to the higher, deadlier doses.
  • Document US6405072 discloses a system and a process for positioning a portion of a patient's body with respect to a treatment machine including multiple cameras to identify and locate index markers mounted to the patient anatomy. Movements of the patient based on comparative analysis of imaging determined anatomical targets relative to reference points on treatment apparatus are controlled by the system and process.
  • Embodiments of the present invention provide systems and methods for localizing, verifying, and validating the position of a cancerous organ, lesion, or tumor (collectively referred to herein as a lesion) with respect to its intended treatment position prior to the delivery of radiation treatment, preferably using visual confirmation of the position of the organ or lesion with respect to the MLC port shape (as determined by the placement of the MLC leaves).
  • the invention relates to fixing one or more representations of beam shapes corresponding to a treatment device during a treatment planning session and a pre-treatment image of the lesion to be treated to a common coordinate system such that the two images can be aligned, and proper patient and/or organ positional adjustments can be made.
  • the present invention facilitates rapid and accurate treatment position verification just prior to treatment delivery in a fraction of the time required by conventional methods.
  • a method for improved spatial localization of a patient's lesion for the purpose of administering radiation treatment includes obtaining a first beam shape representation (generated, for example, during a treatment planning session) with respect to the beam direction of the treatment device, obtaining an image corresponding to the lesion from the beam direction of the treatment device (during, for example, a treatment delivery session) and fixing the first beam shape and the image to a common coordinate system to facilitate alignment.
  • the treatment device can include one or more beam-shielding devices that affect the beam shape, such as the physical arrangement of the leaves within an MLC.
  • the leaves of the MLC can be adjusted manually, programmatically, or using a combination of manual and programmatic methods to conform the beam shape about the lesion. In some cases, the adjustments can be made during a treatment delivery session.
  • the images corresponding to the tumor or lesion can be any of a three-dimensional ultrasound image, a CT image, an MRI image, or a PET image acquired after the planning stage for the purposes of administering radiation treatment.
  • the image corresponding to the lesion is a three-dimensional image, and may further be rendered as a set of surface elements.
  • the method can further include aligning the image with the beam shape such that the beam shape substantially encompasses the image of the lesion and subsequently adjusting the position of the patient to compensate for the alignment, adjusting the position of the patient in real time such that the beam shape substantially encompasses the lesion, or in some cases adjusting the leaves of the MLC such that the adjusted beam shape encompasses the lesion.
  • both the beam shape and the patient position can be adjusted such that the beam shape encompasses the lesion.
  • the method may further include obtaining additional beam shape representations from different directions, and fixing each of the beam shape representations and the three-dimensional image to the common coordinate system.
  • the beam shape representations can comprise an MLC intersection volume, thus allowing the three-dimensional image and the MLC intersection volume to be aligned. The patient position can then be adjusted according to the alignment.
  • the common coordinate system can be established using a laser system in, for example, a treatment room.
  • a system for positioning a patient for the administration of radiation treatment of a lesion includes a register for establishing one or more beam shape representations taken from one or more perspectives of a treatment device; a processor for determining an alignment of the beam shape representations with an image corresponding to the lesion using a common coordinate reference system (established, for example, using a laser system arranged in a treatment room) such that the image is substantially encompassed by the beam shape representations; and a controller for controlling a patient support device in accordance with the alignment.
  • a common coordinate reference system established, for example, using a laser system arranged in a treatment room
  • the treatment device can include one or more beam-shielding devices that affect the beam shape, such as the physical arrangement of the leaves within an MLC.
  • the leaves of the MLC can be adjusted manually, programmatically, or using a combination of manual and programmatic methods to conform the beam shape about the lesion.
  • the beam shape representations can comprise an intersection volume.
  • the images corresponding to the lesion can be any of a three-dimensional ultrasound image, a CT image, an MRI image, or a PET image acquired after the planning stage for the purposes of administering radiation treatment.
  • the processor can further segment the image into a set of surface elements.
  • the controller can adjust the position of the patient support device such that the beam shape substantially encompasses the lesion, or in some embodiments, align the image and the beam shape representations, and subsequently adjust the position of the patient accordingly.
  • FIG. 1 is an elevation of an MLC used in an embodiment of the invention.
  • FIG. 2 schematically illustrates a beam shape generated by the MLC of FIG. 1 .
  • FIG. 3 is a simplified representation of a different beam shape generated by the MLC of FIG. 1 .
  • FIG. 4 schematically illustrates anatomical features of a patient.
  • FIG. 5 illustrates the beam shape of FIG. 3 against the anatomical features shown in FIG. 4 .
  • FIG. 6 illustrates the beam shape of FIG. 3 fully surrounding one of the anatomical features shown in FIG. 4 .
  • FIG. 7 shows a series of cross-sections of an anatomical feature taken along the section lines shown.
  • FIGS. 8A-8C illustrate the manner in which a single anatomical structure, varying in profile, is surrounded by a beam shape from each of multiple beam perspectives.
  • FIG. 9 is a flow diagram illustrating various embodiments of localization, alignment, and adjustment according to an embodiment of the invention.
  • FIG. 10 schematically illustrates a room in which the methods and systems of an embodiment of the invention can be used.
  • FIG. 11 is a schematic illustration of various embodiments of a system adapted to practice the methods of the present invention.
  • 3DCRT Three-dimensional conformal radiation therapy
  • a 3DCRT device used in conjunction with the present invention generally includes a beam-shielding device within the treatment head of a treatment device, a control unit within a housing connected to a treatment processing unit, and a gantry which can be rotated about an axis in the course of a therapeutic treatment.
  • the treatment head is fixed to the gantry for movement around the treatment table, and includes a linear accelerator for generating high powered radiation such as electron, photon, or other detectable types of radiation suitable for the treatment of patients.
  • the radiation beam is focused at a structure, tumor, or lesion within a patient at the intersection of the radiation beam axes (the "isocenter").
  • the rotatable gantry allows for different beam angles and radiation distributions without having to move the patient.
  • a beam-shielding device 100 is provided in the path of each beam to define a radiation field.
  • a beam-shielding device 100 is a multi-leaf collimator ("MLC") that includes a plurality of opposing plates or leaves 110, 120 mounted between the radiation source and patient.
  • the leaves 110, 120 can vary in width, length, or thickness, and are substantially impervious to the emitted radiation. Adjusting the leaves 110, 120 blocks the radiation according to the leaf pattern, thus shielding healthy tissue from the radiation being applied to the tumor.
  • the leaves 110, 120 are movable in a direction generally perpendicular to the beam as to allow for changes in the size and shape of an irradiation field 140.
  • FIG. 2 illustrates the resulting sectional representation 200 of the radiation field, including a shielded area 205 and an outline of the unshielded area 210. Also denoted is the x-axis 220 and y-axis 225 of the MLC, which converge at the treatment isocenter 130 of the field.
  • the axes 220, 225 define a common coordinate reference system for use in registering the beam shape with other images, and coincide with the laser coordinate system found in the treatment room, which also intersect at the treatment isocenter 130.
  • beam shapes are generally generated as the maximum projected shape of the target at isocenter 130 for the given beam direction.
  • FIG. 3 illustrates one possible representation of a coarse representation of a resulting beam shape 300 simplified for illustrative purposes.
  • FIG. 4 illustrates a composite image 400 characterizing the target structure 410 and a nearby normal structure 420.
  • the target structure can be any anatomical feature such as a cancerous organ, tumor, or lesion such as a lymph node in the neck region, a cancerous prostate, or a tumor bed in a breast.
  • the target structure 410 can also represent a non-cancerous organ to be used as a landmark for positioning the patient during treatment planning and/or treatment delivery.
  • the target structure 410 is located proximate to a critical normal structure 420 such as the bladder, the rectum, the spinal cord, or other healthy tissue.
  • the goal of conformal therapy is to deliver the appropriate amount of prescribed radiation to the target structure 410 while minimizing the exposure of the normal structure 420.
  • the target structure 410 and the normal structure 420 images are acquired relative to a treatment coordinate system defined by the treatment isocenter 430 and the x-axis 440, y-axis 445, and z-axis (not shown) lasers which intersect at the treatment isocenter 430.
  • the images characterizing the target structure are obtained just prior to treatment to observe the most current size, shape, and placement of the target structure 410 and any surrounding tissue or organs.
  • the images of the target structure 410 and normal structure 420 can be represented in two or three dimensions, and generated using one or more of numerous techniques known in the art such as three-dimensional ultrasound imaging, CT scanning, magnetic resonance imaging, or PET scanning.
  • the scanning devices are referenced to the treatment coordinate system defined by the treatment isocenter 430, and the treatment coordinate axes 440 and 445 so as to obtain images of the anatomical structures of interest using the treatment coordinate system.
  • the images can be semi-automatically segmented and/or mapped from 3D ultrasound scans of the pelvis using image segmentation and/or contour mapping methods known in the art.
  • the structures 410, 420 can be manually contoured or segmented from CT scans, MRI scans, or PET/CT scans acquired at treatment time with the patient in the treatment position using similar techniques.
  • the beam shape 300 generated during the treatment planning session is registered with the images corresponding to the target structure 410 and normal structure 420 generated during the treatment session and in anticipation of treatment radiation delivery, by aligning the MLC treatment coordinate system defined by 130, 220, and 225 and the image treatment coordinate system defined by 430, 440, and 445, respectively, to create composite images 500 and 600.
  • the beam shape 300 can be manipulated and selectively superimposed onto the images of the target structure 410 and normal structure 420.
  • the composite image 500 indicates that the beam shape 300 designed during treatment planning is misaligned with the target structure 410.
  • the misalignment of the beam shape 300 and the target structure 410 can be a result of improper patient positioning or movement of the target structure, and thus repositioning of the patient is called for.
  • the misalignment can be caused by changes in the physical characteristics of the target structures 410, such as growth or morphism. In some cases, both are present.
  • the originally planned beam shape 300 and/or the current patient positioning is not optimal.
  • the position of the lesion 410 with respect to the treatment coordinate system and treatment isocenter of the MLC can be adjusted such that the lesion 410 is aligned with the beam shape 300.
  • the beam shape 300 can be modified to address any physical changes of the target structure 410 or surrounding normal structures 420.
  • FIG. 6 illustrates the beam shape 300 and the target structure 410 post-alignment, where the beam shape 300 fully encompasses the lesion 410.
  • the optimal alignment may be such that the beam shape 300 does not fully encompass the target structure 410 due to nearby organs that cannot withstand the radiation treatment, or complex shaping of the structure 410.
  • FIG. 7 is a volumetric representation of the corrected alignment of FIG. 6 showing the MLC volume encompassing the 3D tumor image.
  • Arbitrary cross-sectional planar reconstructions of the MLC volume and the 3D tumor image can be obtained to further aid in patient localization and alignment.
  • four planar-reconstruction cross-sectional images, 705, 710, 715, and 720 of the target structure 410 represent different cross-sectional outlines of the target structure 410 along arbitrarily selected planes through the reconstructed 3D tumor image.
  • the corresponding planar-reconstruction cross-sectional images of the MLC volume are also shown, 725, 730, 735, and 740.
  • the MLC volume encompasses all (or in some cases substantially all) of the target structure 410 at that particular cross-section of the target structure 410.
  • the four beam shapes can then be used to verify more comprehensively size, shape, and location of the target structure 410 just prior to treatment using the methods and systems described herein.
  • Beam shapes can be obtained from different beam directions, thus providing additional opportunities to conform (on a beam-by-beam basis) the treatment plan to the shape of the target structure 410 and allowing for more accurate positioning of the patient prior to treatment.
  • FIG. 8 illustrates three views of the target structure 410 and the normal, healthy structure 420, registered with three different beam shapes 805, 810, and 815, and the associated coordinate system axes 220, 225, each taken from a different beam direction, or "beam's eye view" through the leaves of the associated MLC.
  • a radiation oncologist or other radiation treatment planning specialist determines an optimal beam shape 805 for the lesion 410 from a first direction, as described above.
  • the gantry After determining a first appropriate beam shape 805, the gantry is rotated, within the treatment planning simulation software, changing the beam direction such that the radiation addresses the target structure 410 from a different angle.
  • the process of adjusting the leaves is repeated, and a second beam shape 810 is determined for the second treatment angle. This can be repeated any number of times, until the physician or other dosimetry specialist is satisfied that the treatment plan is appropriate and that the prescribed dose can be delivered to the target with as much sparing of health surrounding structures.
  • the multiple beam shapes may be combined into a three-dimensional volume that represents the intersection of all beams the desired radiation field from multiple beam directions, whereas in some embodiments the appropriate alignment for each beam shape is determined on a beam-by-beam bases, and the results are then used in conjunction with each other to adjust the patient position.
  • the treatment plan designed during the treatment planning session is then used to deliver the radiation during one or more treatment delivery sessions.
  • treatment delivery occurs within a few days or weeks of the preparation of the treatment plan, and can include one or more sessions, depending on the type of lesion being treated, the patient's overall health, as well as other factors.
  • the lesion being treated and surrounding tissue and organs can undergo morphological changes and move between the planning stage and treatment delivery, as well as between each treatment session.
  • the treatment delivery sessions can occur over a period of weeks or even months, giving rise to further uncertainties in patient positioning and physiology.
  • the multiple beam shapes 805, 810, and 815 or more generally, arbitrary multi-planar reconstruction beam shapes 725, 730, 735, and 740 can be used to validate location and to adjust the patient position within three dimensional space.
  • the technician Prior to a radiation treatment session, the technician obtains updated images, such as three-dimensional ultrasound images, of the target structure 410 and surrounding tissue that characterizes the most current position and shape of the structure, which are then superimposed with the previously obtained intersection volume derived from the multiple beam shapes 805, 810, and 815.
  • the updated images are then aligned to the coordinate system of the intersection volume, in the case where the beam shapes are combined into a volume, or on sequentially on a beam-by-beam basis.
  • Updated images can be obtained prior to the first treatment session and all subsequent sessions, or some subset of the treatment sessions, depending on the amount of time between sessions, the anatomy of the patient, as well as other factors.
  • the beam shapes from multiple beam directions can be modified in order to encompass the lesion without having to move the patient or the patient support device.
  • the technician can determine the proper adjustments to make such that the target structure 410 is substantially encompassed within the target volume.
  • the adjustments can be made by manually simulating movement of the target structure 410 using a device such as a pointer, a computer mouse, or other such input device and translating the simulated movements into absolute changes in patient positioning either through movement of a patient support device such as a treatment table, movement of the patient with respect to the treatment table, or both.
  • the adjustments can be made programmatically using software, e.g., using image-manipulation programs that find the best fit of a beam profile over a target structure.
  • the technician can progressively adjust the patient or patient support device directly while viewing the results of the adjustments on a computer monitor until the desired position is achieved.
  • FIG. 9 illustrates various embodiments of a method of localization and the resulting alignment and adjustment to improve the delivery of radiation treatment to a patient.
  • the process is typically divided into two phases: a treatment planning phase (identified as the elements to the left of the dashed line 900 ), during which an oncologist or similarly trained physician prepares a treatment plan for the administration of radiation to a cancerous lesion; and a treatment preparation phase (identified as the elements to the right of the dashed line 900 ) during which a radiology technician positions the patient on the treatment table, makes any adjustments to the positioning based on lesion morphing or shifting, and administers the radiation according to the treatment plan.
  • a treatment planning phase identified as the elements to the left of the dashed line 900
  • a treatment preparation phase identified as the elements to the right of the dashed line 900
  • the treatment planning phase can occur substantially before the treatment preparation phase, or in some cases immediately preceding the treatment preparation phase, and may take place in the same room, or in some cases different rooms. As the time span increases between the phases, the target lesion has a greater opportunity to grow, morph, and change its positioning with respect to surrounding normal tissue and healthy organs, thus resulting in a need for positional compensation.
  • an oncologist or other specialist trained in dosimetry planning determines the number of beams (step 903 ) necessary to deliver the appropriate radiation to the target lesion and to avoid subjecting healthy tissue to harmful levels.
  • the beam shape is the maximum projected (step 905 ) shape at the isocenter of the target lesion from a particular beam direction.
  • a determination is then made (step 910 ) as to whether the beam shape accurately reflects the shape and size of the lesion. If the beam shape is not accurate, the leaves are adjusted (step 915 ) and the beam shape is re-projected (step 905 ) and again compared to the lesion.
  • the adjustments to the leaves can be made manually by physically moving one or more leaves in a lateral direction perpendicular to the radiation beam.
  • the operator indicates the desired changes to the beam shape using a data input device such as a touch screen, a pointing device, or a keyboard, and the leaves are adjusted programmatically (or the adjustments are simulated) according to the instructions from the operator.
  • the beam shape encompasses the lesion, it is captured (step 920 ) as an image, such as the beam shape 300 illustrated in FIG. 3 .
  • the accuracy of the patient positioning can be further verified by aligning multiple beam shapes taken from separate directions with the image of the lesion for the corresponding beam directions.
  • the user determines if the number of beams stipulated by the physician in step 903 have been captured (step 930 ). If additional beams are needed, the beam direction is adjusted (step 935 ), and the process repeats: projecting the beam shape for each beam direction (step 905 ), determining if it is properly shaped (step 910 ), and potentially adjusting the leaves (step 915 ) to obtain the preferred beam shape (step 920 ).
  • the beam shapes can be combined into a beam shape intersection volume describing the radiation treatment plan as a three-dimensional model of the radiation field to be delivered to the patient, or used sequentially to determine a beam-by-beam alignment. Because the beam shapes are generated using the MLC device, the beam shapes can be aligned with the coordinate system of the MLC (step 940 ) which is equivalent to the treatment coordinate system.
  • One example of a preferred alignment places the intersection of the axes at the treatment isocenter of the MLC radiation field, as illustrated in FIG. 2 .
  • one or more images characterizing the lesion is generated (step 945 ) using one or more of the imaging modalities described above. Such images are taken in anticipation of the delivery of the radiation treatment to confirm lesion and/or organ location and identify any changes to the lesion. Images of the lesion are taken relative to the treatment coordinate system (step 950 ). The beam shape (in the case of a two-dimensional image) or the beam intersection volume (in the case of a three-dimensional image) is then registered with, or superimposed on the image by registering their common reference coordinate system (step 955 ).
  • the image can be manipulated such that the target lesion is substantially encompassed in the beam shape (step 960 ).
  • the process of aligning the characterization of the target lesion to the beam shape involves moving the lesion with respect to the x-axis and/or the y-axis and/or z-axis of the coordinate system using any of a variety of image manipulation techniques.
  • An example of output from the alignment step is a set of displacements (e.g., - 4 pixels in the x direction, + 8 pixels in the y direction and +12 pixels in the z direction) that describe the movement from the original position of the target structure to the position in which it is encompassed by the beam shape.
  • displacements can then be translated into a set of displacements for a patient support device, such as a treatment table of the LINAC, or the patient, just prior to treatment delivery.
  • a displacement of (-4, +8, +12) may translate into moving the treatment table 4 millimeters to the left, 8 millimeters up, and 12 millimeters in with respect to the gantry.
  • a technician may use real-time or virtual simulation techniques to bypass the alignment step and directly manipulate the patient or patient support device (step 965 ) while viewing the beam shape and a real-time image of the structure on a screen or monitor.
  • a technician can adjust the treatment table position with respect to the MLC until the image of the target structure is encompassed in the beam shape by manipulating an input device such as a joystick, keypad, or other input device and the use of beam's-eye-view or room-view displays.
  • the technician manually adjusts the position of the patient on a stationary treatment table until the desired position is reached.
  • the technician may employ a combination of both programmatic adjustments based on pre-determined alignment displacements, and manual patient positioning techniques.
  • the technician may alter the shape of the MLC port by adjusting the leaves just prior to treatment in lieu of moving the patient to correct displacement of the lesion, or for changes in the shape of the target lesion (due to swelling or other morphology), which may not be addressable by rotation or translation.
  • the target lesion can grow such that changing the MLC beam shape from each beam direction is the preferred method of treating the lesion in its entirety.
  • FIG. 10 illustrates one example of how a laser sight system placed within a room is used to create the common coordinate system.
  • the room 1000 can be used for treatment planning, treatment delivery, or both.
  • a series of lasers 1005 are placed about the walls and/or ceiling of the room 1000 such that every position in space within the room 1000 can be expressed as a distance from the intersection of the laser beams 1005 along a set of axes 1010, 1015, 1020.
  • MLC not shown
  • the lasers can be aimed such that the intersection point of the beams corresponds to the isocenter 130 of the MLC, and the axes of the laser sight system and the MLC can be aligned.
  • FIG. 11 schematically represents a hardware embodiment of the invention realized as a system 1100 for positioning a patient for the administration of radiation therapy.
  • the system 1100 comprises a register 1105, a data processing device 1110, and a controller 1115.
  • the register which may be any known organized data storage facility (e.g., partitions in RAM, etc.) 1105 receives images from an imager 1120 such as an MRI, CT/PET scanner, or ultrasound device. In some embodiments, the images can be stored on a data storage device separate from the imager (e.g., a database, microfiche, etc.) and sent to the system 1100.
  • the register also receives a beam shape image from an MLC 1130.
  • the beam shape can be a single image, and therefore a two-dimensional representation of the beam shape, or multiple images, which can be combined to comprise a three-dimensional intersection MLC volume.
  • the register may receive the images and beam shapes through conventional data ports and may also include circuitry for receiving analog image data, and analog-to-digital conversion circuitry for digitizing the image data.
  • the register then provides the image and the beam shape(s) to the processor 1110 which registers the image and the beam shape(s) into one image using the common reference treatment coordinate system from the medical imaging device 1120 or the MLC 1130.
  • the processor 1110 then either programmatically, or in response to instructions from the user of the system 1100, determines the proper alignment of the beam shape and the image such that the target lesion is substantially encompassed in the beam shape, or, in the case of multiple beam shapes defining an intersection volume, such that the lesion is substantially encompassed by the intersection volume from multiple beam directions.
  • the processor calculates a set of displacements based on the movements needed for proper alignment of the image and beam shapes, which in turn are communicated to the controller 1115.
  • the controller translates displacements into instructions representing physical movements of a patient support device 1140 and sends the instructions to the device 1140 in order to adjust the position of the patient in accordance with the alignment calculations.
  • the processor 1110 may also find the best fit of a beam shape to the lesion and suggest MLC variations to minimize radiation that is outside the lesion, to create treatment margins as described above, or as otherwise needed.
  • the register 1105, processor 1110, and controller 1115 may implement the functionality of the present invention in hardware or software, or a combination of both on a general-purpose computer.
  • a program may set aside portions of a computer's random access memory to provide control logic that affects one or more of the image manipulation, fusion, alignment, and support device control.
  • the program may be written in any one of a number of high-level languages, such as FORTRAN, PASCAL, C, C++, C#, Java, Tcl, or BASIC. Further, the program can be written in a script, macro, or functionality embedded in commercially available software, such as EXCEL or VISUAL BASIC.
  • the software could be implemented in an assembly language directed to a microprocessor resident on a computer.
  • the software can be implemented in Intel 80x86 assembly language if it is configured to run on an IBM PC or PC clone.
  • the software may be embedded on an article of manufacture including, but not limited to, "computer-readable program means" such as a floppy disk, a hard disk, an optical disk, a magnetic tape, a PROM, an EPROM, or CD-ROM.

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  • Radiology & Medical Imaging (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
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  • General Engineering & Computer Science (AREA)
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  • Radiation-Therapy Devices (AREA)
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Claims (32)

  1. Procédé permettant une localisation spatiale améliorée de la lésion d'un patient (410) en vue de l'administration d'un traitement par rayonnement, le procédé comprenant les étapes ci-dessous :
    (a) obtention (905, 910, 920, 930) de plusieurs représentations de formes de faisceaux (300), chacune le long d'une direction d'un faisceau correspondant d'un dispositif de traitement ;
    (b) construction d'un volume d'intersection tridimensionnel sur la base des plusieurs représentations de formes de faisceau ;
    (c) obtention (945) de plusieurs images correspondant à la lésion (10), à partir de chacune des directions des faisceaux du dispositif de traitement ;
    (d) construction d'une image tridimensionnelle de la lésion sur la base des plusieurs images ;
    (e) fixation (940, 950, 955) du volume d'intersection tridimensionnel et de l'image tridimensionnelle de la lésion sur un système de coordonnées commun en vue de faciliter l'alignement volumétrique entre eux ;
    (f) construction d'une image tridimensionnelle comprenant l'image tridimensionnelle de la lésion et le volume d'intersection tridimensionnel sur la base du système de coordonnées commun ; et
    (g) obtention de plusieurs reconstructions de section transversale (705, 710, 715, 720) de l'image tridimensionnelle, chaque reconstruction de section transversale comprenant une représentation bidimensionnelle de la lésion (410) et du volume d'intersection.
  2. Procédé selon la revendication 1, dans lequel le dispositif de traitement englobe un ou plusieurs dispositifs de protection contre les faisceaux (100) affectant la forme des faisceaux.
  3. Procédé selon la revendication 2, dans lequel le dispositif de protection contre les faisceaux (100) est un MLC (collimateur multilame).
  4. Procédé selon la revendication 3, dans lequel les représentations des formes de faisceaux sont basées, au moins en partie, sur l'agencement physique des lames (110, 120) dans le MLC.
  5. Procédé selon la revendication 4, dans lequel les représentations des formes de faisceaux sont ajustées en ajustant les positions des lames (110, 120) dans le MLC.
  6. Procédé selon la revendication 5, comprenant en outre des lames d'ajustement (110, 120) dans le MLC en vue de l'adaptation des formes de faisceaux (300) autour de la lésion (410).
  7. Procédé selon la revendication 6, dans lequel les lames (110, 120) sont ajustées manuellement.
  8. Procédé selon la revendication 6, dans lequel les lames (110, 120) sont ajustées par programme.
  9. Procédé selon la revendication 6, dans lequel l'ajustement est effectué au cours de la session de planification du traitement.
  10. Procédé selon la revendication 1, dans lequel les plusieurs images comprennent des images sélectionnées dans le groupe constitué par une image ultrasonique tridimensionnelle, une image de tomographie, une image RMI, et une image TEP acquises après la planification pour les objectifs du traitement.
  11. Procédé selon la revendication 1, dans lequel les formes de faisceaux (300) sont produites au cours d'une session de planification du traitement.
  12. Procédé selon la revendication 1, dans lequel le système de coordonnées est établi par l'intermédiaire d'un système laser agencé dans une salle d'administration du traitement.
  13. Procédé selon la revendication 1, dans lequel les images sont fixées sur le système de coordonnées au cours d'une session d'administration du traitement.
  14. Système de positionnement d'un patient en vue de l'administration d'un traitement par rayonnement d'une lésion (410), le système comprenant :
    (a) un registre pour établir plusieurs représentations de formes de faisceaux (300), prises chacune à partir d'une ou de plusieurs perspectives d'un dispositif de traitement ;
    (b) un processeur pour établir un volume d'intersection tridimensionnel sur la base des plusieurs représentations de formes de faisceaux, pour déterminer un alignement du volume d'intersection tridimensionnel et de l'image tridimensionnelle correspondant à la lésion (410) par l'intermédiaire d'un système de référence de coordonnées commun, de sorte que l'image tridimensionnelle correspondant à la lésion (410) est pratiquement renfermée de manière volumétrique par le volume d'intersection tridimensionnel, et pour obtenir plusieurs reconstructions de section transversale (705, 710, 715, 720) du volume d'intersection tridimensionnel et de l'image tridimensionnelle superposés, chaque reconstruction de section transversale comprenant une représentation bidimensionnelle de la lésion (410) et du volume d'intersection ; et
    (c) un dispositif de commande pour contrôler un dispositif de support du patient en fonction de l'alignement.
  15. Système selon la revendication 14, dans lequel le dispositif de traitement englobe un ou plusieurs dispositifs de protection contre les faisceaux (100) affectant la forme des faisceaux.
  16. Système selon la revendication 15, dans lequel le dispositif de protection contre les faisceaux (100) est un MLC.
  17. Système selon la revendication 16, dans lequel les représentations des formes de faisceaux sont basées, au moins en partie, sur l'agencement physique des lames (110, 120) dans le MLC.
  18. Système selon la revendication 17, dans lequel les représentations des formes de faisceaux sont ajustées en ajustant les positions des lames (110, 120) dans le MLC.
  19. Système selon la revendication 18, dans lequel les lames (110, 120) sont ajustées manuellement.
  20. Système selon la revendication 18, dans lequel les lames (110, 120) sont ajustées par programme.
  21. Système selon la revendication 18, dans lequel l'ajustement est effectué au cours de la session de planification du traitement.
  22. Système selon la revendication 14, dans lequel l'image tridimensionnelle est construite à partir d'une ou de plusieurs images sélectionnées dans le groupe constitué par une image ultrasonique tridimensionnelle, une image de tomographie, une image RMI, et une image TEP acquises après la planification pour les objectifs du traitement.
  23. Système selon la revendication 14, dans lequel l'image correspondant à la lésion (410) est une image tridimensionnelle, le processeur segmentant l'image en un ensemble d'éléments de surface.
  24. Système selon la revendication 14, comprenant en outre un système laser agencé dans la salle d'administration du traitement pour établir le système de référence de coordonnées commun.
  25. Système permettant une validation spatiale améliorée de la position de la lésion d'un patient (410) en vue de l'administration d'un traitement par rayonnement, comprenant :
    (a) un moyen pour obtenir plusieurs représentations de formes de faisceaux (300), chacune le long d'une direction d'un faisceau correspondant d'un dispositif de traitement ;
    (b) un moyen pour construire un volume d'intersection tridimensionnel sur la base des plusieurs représentations de formes de faisceaux (300) ;
    (c) un moyen pour obtenir plusieurs images correspondant à la lésion d'un patient (410), à partir de chacune des directions des faisceaux du dispositif de traitement ;
    (d) un moyen pour construire une image tridimensionnelle de la lésion sur la base des plusieurs images ;
    (e) un moyen pour fixer le volume d'intersection tridimensionnel et l'image tridimensionnelle de la lésion sur un système de coordonnées commun en vue de faciliter l'alignement volumétrique entre eux ; et
    (f) un moyen pour obtenir plusieurs reconstructions de section transversale (705, 710, 75, 720) du volume d'intersection tridimensionnel et de l'image tridimensionnelle, chaque reconstruction de section transversale comprenant une représentation bidimensionnelle de la lésion et du volume d'intersection.
  26. Système selon la revendication 25, comprenant en outre un moyen pour ajuster un ou plusieurs dispositifs de protection (100) dans le dispositif de traitement en vue de l'adaptation des représentations des formes de faisceaux autour de la lésion.
  27. Système selon la revendication 6, dans lequel les faisceaux sont ajustés manuellement.
  28. Système selon la revendication 26, dans lequel les faisceaux sont ajustés par programme.
  29. Système selon la revendication 25, comprenant en outre un moyen pour segmenter l'image correspondant à la lésion d'un patient (410) en un ensemble d'éléments de surface.
  30. Système selon la revendication 25, comprenant en outre un moyen pour ajuster la position du patient de sorte que le volume d'intersection tridimensionnel renferme pratiquement l'image tridimensionnelle de la lésion.
  31. Système selon la revendication 25, comprenant en outre un moyen pour aligner la lésion tridimensionnelle de l'image avec le volume d'intersection tridimensionnel, de sorte que l'image tridimensionnelle de la lésion est pratiquement renfermée dans le volume d'intersection tridimensionnel.
  32. Système selon la revendication 14, dans lequel le processeur est en outre configuré de sorte à ajuster la position du patient, de sorte que chaque représentation bidimensionnelle de la lésion (410) est pratiquement renfermée dans sa représentation bidimensionnelle correspondante du volume d'intersection.
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EP1778351A1 (fr) 2007-05-02
US20100268073A1 (en) 2010-10-21
US20060020195A1 (en) 2006-01-26
CA2574669C (fr) 2016-05-24
WO2006007694A1 (fr) 2006-01-26
CA2574669A1 (fr) 2006-01-26
EP1778351A4 (fr) 2010-01-06
ATE523224T1 (de) 2011-09-15
US7729744B2 (en) 2010-06-01
ES2370747T3 (es) 2011-12-22

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